Toss out the inhaler if you outgrow asthma? Not so fast

NEW YORK (Reuters Health) - Tossing out the inhaler may not always be the best response to outgrowing asthma, new research suggests.

About 1 in every 10 children in the U.S. has the chronic lung disease. If he or she is also among the roughly 1 percent of children with a peanut allergy, using an inhaler could prove lifesaving even after asthma symptoms have disappeared, researchers found.

Children with the common duo of conditions are known to be at a greater risk of life-threatening allergic reactions to peanuts, making it especially important for their asthma to stay well controlled with an inhaled steroid or other anti-inflammatory medication. What has not been clear is what should be done when a youngster with a peanut allergy outgrows their asthma.

Research shows that about 60 to 70 percent of kids with asthma will outgrow it by the time they reach their teens. Normal practice is to withdraw the therapy, lead researcher Dr. Michael Shields of Queen's University of Belfast, in the United Kingdom, noted in an email to Reuters Health. But is this always a wise decision?

If allergic inflammation persists in the airway of a peanut-allergic kid, then maybe not, Shields said.

In the study, he and his colleagues assessed the airways of about 100 British children younger than age 16, all with peanut allergy. They grouped the participants into four categories of asthma history: never wheezed, currently treated for asthma, moderate wheezing but not taking medication, and outgrown asthma.

For each child, the researchers measured the level of nitric oxide in exhaled breath, which is thought to reflect the degree of inflammation in the airways.

All 7 of the kids who had seemingly outgrown their asthma as well as 15 of 20 (75 percent) with untreated wheeze showed high levels of exhaled nitric oxide, indicating on-going inflammation. Levels were not elevated among kids currently treated for asthma or those with no history of wheezing, the researchers report in the journal Pediatric Allergy and Immunology.

Given these findings, they say the term "outgrown" may be misleading.

Shields suggests doctors consider using low levels of inhaled steroids for kids with lingering inflammation, in the hope that this might reduce their risk of a nasty peanut-induced asthmatic attack.

But Dr. Fred Finkelman of Cincinnati Children's Hospital Medical Center in Ohio thinks such advice would be premature. "There are risks to taking all medications, including inhaled corticosteroids," Finkelman told Reuters Health in an email. "And the overall risk of having a large number of individuals taking such a medication might be greater than the potential, undefined decrease in the risk of a severe asthma attack in a very small percentage of people."

About 100 Americans die every year from a severe allergic reaction to food, he added, with peanuts and tree nuts being the most common triggers.

The British researchers also point to some limitations to their findings, including the small number of children with outgrown asthma in the study and the lack of an agreed upon level of exhaled nitric oxide for which treatment should be prescribed.

And Shields noted that the benefits of continued corticosteroid use would be difficult to prove. "This is because, thankfully, severe reactions are quite rare," he said. "And we strongly recommend those with [peanut allergy] to strictly avoid such exposures."